Smrithi Karthikeyan Week 1: Immersion Begins!

During my first week shadowing in the Department of Cardiology, I had the privilege of seeing various procedures starting Day 1! Before walking into the OR, I had a chance to sit in on a cardiac MRI reading where physicians discussed what to include in their "impressions" for the patient. The impression is a section of a patient's radiology report that summarizes the radiologist's most important findings: any abnormalities, potential diagnoses, and suggestions for additional tests/followups. Cardiac MRI is the current gold standard for evaluating both heart structure and function. One of the main advantages of cardiac MRI is its ability to provide detailed, reliable tissue characterization (such as scar tissue and inflammation). 

After the reading session, I got a chance to watch an electrophysiology ablation procedure to treat atrial fibrillation. In the control room, I got to meet a few Medtronic representatives (who are experts with the Affera Mapping and Ablation System) support the physical mapping of electrical circuits in the heart. The market-differentiating factor of the Affera System is that it can map and ablate with the same catheter. Other systems require two different catheters, which ultimately increases procedure time. The con of this system is that it cannot ablate in regions close to the heart's conduction system. 

On my second day, I got to shadow Dr. Jennifer Jantz read and conduct transesophageal echocardiogram (TEE) procedures. Here, I got to see cases with atrial septal defects (ASD). Sometimes during the TEE, it is difficult to visualize the blood flow in the septal wall (especially if it is hypothesized that this patient would have an ASD). To provide more clarity, microbubble contrast agents were injected through the patient's IV for better visualization. Afterwards, I went over to the cath lab to see an ASD closure procedure where two stents were implanted in the superior vena cava (SVC). It was interesting to see how both fluoroscopy and TEE were used together to determine stent placement. TEE was mostly used to determine whether the stent successfully covered the ASD. 

For the rest of the week, I got to see more TEE and Watchman procedures, sit in on cardiac MRI readings, and shadow physicians on rounds. Overall, I was particularly fascinated by how they determined the most appropriate imaging modality—echocardiography, MRI, or CT—based on each patient’s presentation and clinical needs. Cost and time seemed to be the most important factors for characterizing most pathological conditions. In this case, most patients underwent a CT and a TEE as they are both quick and cost-effective. The biggest struggle that I noticed with physicians was the fact that they wished they got more tissue characterization parameters from echo scans. Perhaps, this would be a good avenue to investigate further during my immersion journey.

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